STREAMLINE DISCHARGE PROCESS / ED MANAGEMENT SERVICES

Identifying Project and Provider Information: Category 2: Implement/Expand
Care Transitions Programs; Project Option 2.12.2: Implement one or more pilot
intervention(s) in care transitions targeting one or more patient care units or a
defined patient population; 094109802.2.4; HCA Las Palmas Del Sol (094109802).
o Required Core Project Component: Conduct quality improvement for the
project using methods such as rapid-cycle improvement. Activities may include,
but are not limited to, identifying project impacts, “lessons learned,” opportunities
to scale all or part of the project to a broader patient population, and key
challenges associated with expansion of the project, including special
considerations for safety-net populations.

Project Description: This project will establish case management and coordinated
discharge planning processes; those processes will be used to identify top chronic
conditions that are common causes of avoidable readmissions and develop
strategies to reduce readmissions in those specific populations. ED discharge is a
prime target for improvement in the delivery of effective discharge instructions,
follow-up care recommendations, referrals to community providers or resources,
matching patients with appropriate community-based resources, and increasing
patient satisfaction. One goal of the project is to create a mechanism to track
unnecessary ED visits and admissions to the hospital and to use this mechanism to
refer the patients to the appropriate community resources. This project will also
incorporate the emergency screening process (ESP). ESP refers to a low-acuity
strategy used to redirect non-urgent patients to appropriate alternative community
resources after they have had a medical screening exam (MSE) performed by a
Qualified Medical Professional (QMP). The goals of the ESP are decreased Left
Prior to Medical Screening Exam (LPMSE), decreased frequent returns to the
emergency department, increased community education and awareness, improved
satisfaction of patients, physicians, and ED staff, and improved overall turn-around
times for truly emergent conditions.
o Challenges: Patient participation; educating practitioners on best practices;
collecting and accurately interpreting the data collected from patients; identifying
the reasons behind and solutions for the most common preventable ED visits and
admissions.

Starting Point/Baseline: As of 2011, the ED does not have case management to
be able to review unnecessary ED visits or admissions and refer to the appropriate
community resources. There is also no mechanism in place to be able to track or
review unnecessary ED visits. Currently, there is no case management
representation in the ED and no processes in place to review unnecessary ED visits
for QI purposes.

Rationale: Case management in the emergency department would reduce
overcrowding, decrease wait times, increase patient and physician satisfaction, and
appropriately utilize community resources. Case managers would also serve as a
resource to the physicians and staff by providing appropriate discharge planning
guidance. Additionally, poorly designed discharge processes create unnecessary
stress for medical staff, causing failed communications, rework, and frustrations. A
comprehensive and reliable discharge plan, along with post-discharge support, can
reduce readmission rates, improve health outcomes, and ensure quality transitions.
Patient transition is a multidimensional concept and may include transfer from facility
to home, or to nursing home, or to home and community-based services, etc.

Related Category 3 Outcome Measure(s): OD-3: Potentially Preventable ReAdmissions—30 day Readmission Rates; IT-3.1: All cause 30 day readmission rate;
(094109802.3.9).

Relationship to Other Projects: This project is part of LPDS’s larger plans to
expand and develop primary care and specialty care services, while improving
access to care and containing the costs of care. It is one of a group of several LPDS
delivery system reforms (i.e., LPDS’s Physician Training and Quality project
(094109802.1.5), Electronic Medical Records project (094109802.2.1), and Evaluate
Hospitalist Model project (094109802.2.3)) which are primarily aimed at improving
models of inpatient care through the implementation of technology, provider
education, quality improvement, and other means. Similarly to LPDS’s Congestive
Heart Failure Clinic project (094109802.2.2) and Develop Diabetes Management
Registry project (094109802.1.3), this project will help individuals with specifically
targeted health conditions to better manage their use of healthcare services from
LPDS and other providers in the El Paso community, ensuring that the delivery and
utilization of healthcare is more efficient from the provider’s perspective and more
effective from the patient’s perspective.

Relationship to Other Performing Providers’ Projects in the RHP: TBD

Plan for Learning Collaborative: TBD

Project Valuation: $4,683,408. The valuation of each LPDS project takes into
account the transformational impact of the project, the population served by the
project (both number of people and complexity of patient needs), the alignment of
the project with community needs, and the magnitude of costs avoided or reduced
by the project. In particular, this project has been valued based on the fact that this
project will identify populations in need of care management to ensure that the
project’s services will be targeted to those populations; this project has also been
valued based on the need of the community in general for more effective and
extensive care management in the ED setting to reduce improper utilization of
emergency healthcare services.
094109802.2.4
Related Category 3
Outcome Measure(s):
Year 2
(10/1/2012 – 9/30/2013)
Milestone 1: Establish baseline
for metrics P-6.1, P-7.1, P-8.1, I10.1, I-11.1, and I-14.1.
Metric 1: Establish baseline for
future years.
Milestone 1 Estimated Incentive
Payment: $1,145,395
2.12.2
2.12.2.X
HCA Las Palmas Del Sol
094109802.3.9
IT-3.1
Year 3
(10/1/2013 – 9/30/2014)
Milestone 2 [P-6]: Train/designate
more ED case managers.
Metric 1 [P-6.1]: Number of trained
and/or designated ED case
managers over baseline.
Baseline/Goal: n/a
Data Source: HR; job
descriptions; training
curriculum.
Milestone 2 Estimated Incentive
Payment: $624,783
Milestone 3 [P-7]: Develop a
staffing and implementation plan to
accomplish the goals/objectives of
the care transition program.
Metric 1 [P-7.1]: Documentation of
the staffing plan.
Baseline/Goal: n/a
Data Source: Staffing and
implementation plan.
Milestone 3 Estimated Incentive
Payment: $624,782
STREAMLINE DISCHARGE PROCESS / ED MANAGEMENT SERVICES
094109802
All cause 30 day readmission rate
Year 4
(10/1/2014 – 9/30/2015)
Milestone 4 [I-10]: Identify the top chronic
conditions (e.g., heart attack, heart failure,
and pneumonia) and other patient
characteristics or socioeconomic factors that
are common causes of avoidable
readmissions.
Year 5
(10/1/2015 – 9/30/2016)
Milestone 6 [I-11]: Improve the percentage of
patients in defined population receiving
standardized care according to the approved
clinical protocols and care transitions policies.
Metric 1 [I-10.1]: Identification and report of
those conditions, socioeconomic factors, or
other patient characteristics resulting in
highest rates of readmissions.
Baseline/Goal: Report for DY4.
Data Source: Registry or EHR
report/analysis.
Metric 1 [I-11.1]: Number over time of those
patients in target population receiving
standardized, evidence-based interventions
per approved clinical protocols and
guidelines.
Baseline/Goal: 10% improvement over DY
2 baseline.
Data Source: Registry or EHR
report/analysis.
Milestone 4 Estimated Incentive Payment:
$626,599
Milestone 6 Estimated Incentive Payment:
$517,625
Milestone 5 [I-14]: Implement standardized
care transition process in specified patient
populations.
Milestone 7 [I-14]: Implement standardized
care transition process in specified patient
populations.
Metric 1 [I-14.1]: Measure adherence to
processes.
Baseline/Goal: 10% improvement over DY
2 baseline.
Data Source: Hospital administrative data
and patient medical records.
Metric 1 [I-14.1]: Measure adherence to
processes.
Baseline/Goal: 5% improvement over DY
4.
Data Source: Hospital administrative data
and patient medical records.
Milestone 5 Estimated Incentive Payment:
$626,598
Milestone 7 Estimated Incentive Payment:
$517,625
094109802.2.4
Related Category 3
Outcome Measure(s):
Year 2
(10/1/2012 – 9/30/2013)
Year 2 Estimated Milestone
Bundle Amount: $1,145,395
2.12.2
2.12.2.X
HCA Las Palmas Del Sol
094109802.3.9
IT-3.1
Year 3
(10/1/2013 – 9/30/2014)
Year 3 Estimated Milestone Bundle
Amount: $1,249,565
All cause 30 day readmission rate
Year 4
(10/1/2014 – 9/30/2015)
Year 4 Estimated Milestone Bundle Amount:
$1,253,197
TOTAL ESTIMATED INCENTIVE PAYMENTS FOR 4-YEAR PERIOD: $4,683,408
91313
STREAMLINE DISCHARGE PROCESS / ED MANAGEMENT SERVICES
094109802
Year 5
(10/1/2015 – 9/30/2016)
Year 5 Estimated Milestone Bundle Amount:
$1,035,250